When it’s More than Picky Eating: 4 Warning Signs

Dr. LeeshaMD, MPH

What to Know

Picky eating is super common. I challenge you to find one kid or even one adult who literally will eat anything – this just doesn’t happen. Sometimes kids are simply developing their palate as their taste buds mature. Other times they are boldly declaring their independence by refusing to eat what’s placed in front of them. Or perhaps it’s the color or the texture or the smell. Kids may find particular food characteristics unappealing and refuse to eat certain foods. Overall, picky eating is common especially among toddlers and preschoolers, usually does not impact a child’s growth and development, and improves over time.

Here are 5 tips for parents to help encourage the picky eater to eat a greater variety of foods:

  1. Keep trying – Sometimes a food refusal on Monday will not lead to the same food refusal on Tuesday.
  2. No shaming – Don’t make food avoidance a big deal. We don’t want to shame our children, causing them to feel bad about their lack of acquiescence. Similarly, don’t force them to clean their place or sit at the table until all their food is gone. The goal is to encourage healthy eating habits rather than shameful ones.
  3. Be an “adventurous” eater – You want your kid to try his or her vegetables, then you gotta eat your vegetables, too. Be creative. Perhaps come up with a game to see who will try the most new and different foods over a week’s time, and then the winner gets to pick a fun activity for the family.
  4. Offer choices – Allow your children to pick between 2 or 3 vegetable choices. This allows them to have a say in the decision but without wiggling out of the vegetable-eating requirement.
  5. Eat together – Establish family mealtimes as moments of meaningful connection but also to ensure that all plates are similar. Parents can’t have corn for their side while the kids have beets. That’s just not fair.

So, the bigger question then is how do you know when it’s more than picky eating. Here are 4 warning signs:

  1. Changes in growth – If your child is losing weight, failing to gain weight, or is no longer tracking along their growth curve, then his or her eating habits require further evaluation.
  2. Mealtimes are emotionally distressing – If your child consistently becomes terribly upset or throws a tantrum around meals, then he or she needs to see his pediatrician.
  3. Refusing to eat entire groups of foods like all vegetables or no meats – Many times children may prefer one or two fruits or vegetables or only want chicken nuggets but avoiding entire food groups is concerning.
  4. Severe anxiety around eating – If your child is fearful of experiencing belly pain, worries that he or she will choke, or is scared to eat meals in front of others, these all suggest something more serious.

There are several mental disorders that can occur in younger children outside of Anorexia Nervosa, Bulimia, and Binge Eating Disorder seen more commonly in adolescents and adults that can cause problems with eating.

  • Children can experience pica, a condition when children eat non-food or non-nutritive substances like paper, chalk, or hair.
  • Kids can also have Obsessive Compulsive Disorder (OCD) whose fears drive their disordered eating. A child may refuse to eat certain foods if he or she believes those foods will cause them to choke.  
  • Depressed children may not eat because changes in appetite can be a symptom of depression.
  • According to ADDitude Magazine, kids with Attention Deficit Hyperactivity Disorder (ADHD) may experience sensory challenges around foods or crave sugar because of how their brains are wired, both which lead to problematic eating habits.
  • Rigid food preferences can also be seen in children with Autism Spectrum Disorder who find foods with specific textures or colors completely unappealing and will refuse to eat them.
  • There is a newly recognized eating disorder called Avoidant/Restrictive Food Intake Disorder or ARFID. ARFID was first recognized in 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that came out in 2013.  In her blog post, ARFID Is More Than Just Picky Eating, Dr. Lauren Muhlheim reviews key differences between picky eaters and those with ARFID that rests largely along developmental lines. She notes that 13 – 22% of children between 3 to 11 years of age are considered picky eaters. Most young children grow out of picky eating, but a significant portion (18 – 40%) remain picky into adolescence. Children with ARFID may refuse entire food groups, fail to gain appropriate weight, show problems early on during infancy, have nutritional deficiencies, or struggle with typical childhood activities such as social interactions with peers and being unable to enjoy mealtimes.

What to Do

  1. Understand the difference between picky eating and disordered eating – If your child is a picky eater and still developmentally healthy, try the strategies listed above.
  2. Get help – If your child is losing weight or mealtimes are becoming increasingly stressful, reach out to your child’s primary care provider or pediatrician to complete a thorough medical evaluation that will include a physical exam as well as blood work.
  3. Don’t blame yourself – Disordered eating and even picky eating is not the fault of the parents. Instead of blaming yourself for your child’s eating habits, choose to help your child face eating challenges head on and get the help your child needs.

Let’s Chat!

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